Case study: Future of mental health care: Challenges, innovation & employee impact

As the mental health crisis persists, benefits leaders are faced with the unique challenge of expanding access to mental health care by reaching employees in the moments that matter. In a crowded landscape of solutions for employee mental health- how do you keep it all straight? Join a conversation on challenges, innovation and solutions that have a positive impact on employee mental health.  

Transcription:

Madleine Makori (00:09):

Thank you. Just making sure you can hear me well. Thank you everyone, and welcome. Thank you so much for joining us. My name's Madleine Makori, I'm the senior M S L at Big Health and I am a pharmacist by training and I'm joined by Jen Paisley, who is the VP of Total Rewards and HR Operations over at valmont International or Industry. Sorry. Oh, you're fine. And so we're really excited to be here to talk to you today. And before we get started if you haven't gone to our big health booth yet we do have a QR code that you can scan and we're giving our swag budget to nami, which is a National Alliance on mental Illness. So feel free to go the booth and scan, and I think you might also have a paper at your desk or your chair that you're able to scan for that donation. And so I'm really excited to talk about the future of mental health care and really focusing in on the challenges innovation and that's happening as well as impact on employee health. And so I'll start by setting the stage with talking about the pandemic. So before the pandemic the mental healthcare system was still struggling and has been really expedited, I think during the pandemic. But what we saw before was up to 60% of individuals that had a mental health care condition were not getting the help or the support they needed. And this was perpetuated during the pandemic. So you can think about the adjustment we had to all quickly make to working remotely, childcare being shut down, schools being opened, closed, open and really the overall loneliness and isolation that we felt in our personal lives as well as our professional lives. And so what came into play is we really started to look at our healthcare system and of course with us focusing on the mental healthcare system and the support that we have there. And unfortunately what we see is that up to 20% of the population are suffering from a clinical mental health condition, but only one in 10 in that population are getting treatment from a therapist or a psychiatrist. And then three in 10 are receiving treatment through medications. And of course there's some overlap of individuals getting both, but that leaves us with six out of 10 or 60% of individuals not getting the clinical treatment that they need or the clinical support for their mental healthcare journey. And so the question then becomes, well, what else can we put? What gaps are there that we can fill? What else can we utilize to get mental healthcare to individuals when they need it and when they're raising their hand as well as to the individuals that our silently suffering. And so I think some of that responsibility did fall on the benefits leaders and a lot of us as employees turned around during the pandemic and kind of post in the residual effects. And we're looking at our employers and saying, what do you have to support my mental health journey on top of fertility And a lot of other issues that have come up, what can you offer me? How do I get access to a therapist? How do I get that support? And what are you offering me to help me in that mental health care journey? And since I do have a benefits leader on the stage here, I'll kind of pass it on to her. And I would love Jen to learn your insight on what's changed the last three years for you the kind of challenges you've experienced and the transitions you've had to make because of it.

Jen Paisley (03:26):

Yeah, so I mean obviously we were trying to be competitive through the whole thing before the pandemic, during the pandemic, after the pandemic. I'll just kind of share a couple stories that we went through. Before the pandemic, I was in Valmont and I've been there about five years and we were embarking on a long-term benefit strategy as a whole. So we were just looking at our core benefits, so medical, dental, vision, life, disability, kind of all those things that kind of people think that you need to have from that standpoint. So we started there and we started moving the needle and we started talking to executives. We started talking to them a lot about data and what it looks like, kind of best practices in the market. We didn't have a high deductible health plan we still wanna offer choice within our organization, but there was, I would say, very little choice that we were offering. So we were trying to take a look at all that. Then the pandemic happened we started to move the needle as well on our niche benefits as what we look at as. And we knew that a lot of things with just our demographics with the manufacturing firm, and I know we're going to talk a little bit about what Belmont does, but we were embracing many things all at one time. And those challenges I think are the same for all of us. There were more being put onto our plate. We are hearing about more benefits from that standpoint. So there was all those things that were happening during the pandemic. One of the things that we felt like was the right thing to do was we offered backup child, pet and elder care. We offered it for one year. We took a look at it with our executive team and in about nine months of offering it, we actually had zero utilization. We had not one person embrace that on from a subsidy standpoint. So we quickly reversed that. We thought that's what people needed. We were kind of testing some things that one was one that we didn't necessarily get anybody in. Later on we kind of learned that a lot of our people, they're in rural areas and they do have the support of family and some of those things. But that was one that I feel like was a lessons learned. We were trying to move the needle, we were trying to do it fast in the pandemic. We felt like people are going to struggle with care. And to your point, people, kids are going to school, they're not going to school, they're going to school and all those things. So that was one that we looked at. And then moving in the digital piece the other story I'll say is when we started looking at our benefits in the beginning we started to talk about with our executives kind of what if you could offer two additional benefits? What would they be? And one of our executives said, well, I really wish with, we offered telemedicine and I paused because we did offer telemedicine. So I was like, well shoot, do I tell him, yeah, we do offer that or do I kind of stay silent? I was newer to the organization. I said, well, to be completely transparent with you, we do offer it. So we knew we need to do a better job of how do we communicate it which is always the thing that is the hardest part. How do we get to people at the point of care that the time that they need to seek the peace of care that they're looking for and is it a benefit? So I said, yeah, we do offer it. We did a campaign, we made it sound like it was new. So we launched it in 2019. Again in 2018, we saw about 89 visits from a telemedicine for annually. In 2019, we had over 500 visits. So we definitely, the way we rebranded it did help. And then the pandemic helped us even more from the fact of people were starting to learn about it. They were the registering from that standpoint on telemedicine. And we continued to communicate those pieces. So that was one where I feel like that gave us even more momentum going into the pandemic cuz we had launched that before that we started to look at more digital solutions and we knew that that was a need in the pandemic and then coming out of it as well.

Madleine Makori (07:50):

So speaking to bringing on new benefits and understanding your population and adjusting when it failed and when you needed to bring on new benefits. So thinking about mental healthcare and specifically, what did you realize during the pandemic and how did you adjust to those challenges in bringing on new mental healthcare support?

Jen Paisley (08:09):

Yeah, So our challenges have over 12,000 employees globally. We have an 84% male workforce. We have about 85 manufacturing firms around the world. The facilities, our average age is 43. And so with that, a couple things. Stigma is probably the one piece that we struggle with and it's, it's globally as a whole. We have an 84% male workforce and they kind of just say, you just need to suck it up and we don't wanna talk about it. And we wanna kind of move on with our lives from that standpoint. And I think that's been happening before the pandemic. But we tried to take a transparency approach too. I would say we were in kind of the middle of our wellness journey and our wellbeing. And that's kind of how we started to try to communicate it. And we tried to be open and honest about it and that everyone, we all unique. We all are human beings and we wanna make sure that we're meeting people where they're at. And that's like the hardest thing to do as benefit leaders. And from that standpoint and just HR as a whole. But we definitely started looking at multi-channel communications. We started talking about the physical wellbeing, emotional wellbeing and financial wellbeing and tying it all together because we knew that if we maybe started to talk about our benefits as a whole something would resonate with someone from that standpoint. And then the other thing that we did from a communication standpoint is we really tried to do a one stop shop application. So we are still trying to get everyone to download that application, but that is really where all of our benefits lie. All of our HR pieces lie from that standpoint. So in looking at that stigma was one, I talked about the access to care. We are in a lot of rural areas, so we wanted to make sure people had the same access, we want them to have the same experience or a similar experience. Everyone is individual. So we wanna make sure that those things are unique, but in making sure that it is the same across the board so that whether I live in Belleville, Texas, which is where one of our facilities are, or I live in Omaha, Nebraska, I still have the same access to care. And we know wait times where, they were struggling a lot from that standpoint. And so I think that was a big challenge we had too. So that's kind of why we wanted to shift. The other piece that we learned during the pandemic from a challenge standpoint is we always struggled with our EAP utilization and continue to try to move the needle there but employees and family members thought that EAP could only be accessed an in-person visit. And it was very interesting because we tried to get that communication out very quickly when we found out in the first quarter as we were looking at our data that we saw a big drop off. And a lot of it was because people thought, well, it's the pandemic. I'm not going to go see a counselor. So we quickly tried to move the needle on that too. But then that's where we started to look at more digital pieces as well. In looking at those challenges.

Madleine Makori (11:46):

And I'm going to jump to this slide cause that's a perfect entry as you talk about access to care and in those barriers at big health, that's what our focus is. It's mental health equity and really lowering that bar of access to care to behavioral health support. So we talked about traditionally mental health care looks like either seeing a therapist or psychiatrist or going to see most of us, we go to our PCP, our primary care provider when we have a health issue because they're kind of the gateway or the access, main access point that we know best of to get that care. And so what's a third, fourth, fifth modality? How do we continue to support the mental health care continuum and make sure that people have access, right? So we're talking about whether it's 24 7, 365 something they can do at home, something they can pick up and meet somewhere they're at. And this is where digital medicine, digital therapeutics fall into. And so at Big Health we have two digital therapeutics. We have sleepio for insomnia disorder and then anxiety for generalized anxiety disorder. And you can think of it as digital therapeutics in our case of the cognitive behavioral therapy that's administered from a therapist in live practice. These are research backed efficacy based research tools and treatment tools. We take that, we package it in a way that's more accessible, that can be scaled so the masses can have access. Remember that 60% that is not getting the treatment and they're getting the same level of treatment that's comparable to gold standard. So we're talking about getting them to clinical improvement to a level of remission that you'd wanna see with gold standard treatment and practice with a therapist, but in a way that they can utilize it via software. And again, it meets somewhere they're at and they're able to utilize it when they need it the most. And also accessing those silent sufferers that are not raising their hand publicly, they're not going to the doctor, they're not going to the therapist. And so you can see here that over 70% of our patients in clinical trial are reaching those remission rates. They're getting two levels of insomnia or anxiety symptom levels that no longer score as clinically diagnosable. And then our safety profile is amazing with no serious adverse events reported. But some of the common safety concerns are like, I forgot my password to log to the digital therapeutic and indirectly comparing that to ambient and Xanax, of course as a pharmacist, I have to talk about the medications, but we're not getting that level of efficacy with commonly utilized medications in those therapeutic areas. And what's more to highlight is the safety profiles of these medications. And fortunately people end up cycling through them. A lot of patients don't get well or they can't cope with having a headache or hallucinations or feeling dizzy at work. And so they may not want to take those medications. And so thinking about, well, how does this apply to employers and how does this become part of the ecosystem? And so we have implemented a really low lift for this. And so think about myself, if I'm going to fill my prescription for insomnia, so I'm picking up my Ambien that's going to trigger a mailer or some type of alert that's going to let me know, you know, have access to sleepy or you have access to daylight do you wanna find out what your sleep score is or do you wanna find out what your anxiety type is? So using stigma free language, we're not pointing out that you have insomnia, we're not calling you out for picking up a prescription and then you're invited to take a clinically validated screener and then start the therapeutic. And you as an employer, you're not billed for that until that individual starts that first session, that first dose of the therapeutic. So they can go through steps one through three not jump into the first session, and you'll not be billed when they go into that first session, that first dose of the therapeutic. And so let me pause there turning it back to you, Jen, I would love to know what your experience was getting onboarding big health in our products and the outcomes and the data that you're seeing so far in your employee group.

Jen Paisley (15:59):

Sure. Yeah, So we embarked on this journey almost a year ago and we started with a pilot. So one of the things that we wanted to do is we wanted to start with a pilot. And from a pilot standpoint, we looked at one of our facilities in the US and then we looked at one outside the us. So we went with our Jasper Tennessee location and then we also went with our location in Malaysia. They are very different. And so we had to think about that from a pilot standpoint. And really what we were trying to do is just kind of see, we wanna make sure our communication is sound that we're getting to people and the people are understanding kind of the benefit that we're offering in Jasper, Tennessee. It came from the shared services group, which is our group. And the US people are definitely used to all those things that they're coming from shared services. We took a slightly different approach in Malaysia. So the people we had, we talked to a couple HR and finance groups that support us and they were concerned about rolling it out. They said, people don't talk about having anxiety or worry or they don't get enough sleep. That's just not what people talk about. It's not coming up in conversation. So we just talked through that on a approach of that standpoint. And we know we look at that in the US too when we move the needle a little bit. They were very hesitant. So one of the things we talked about from a communication standpoint is this communication does not have to come from us as a shared services group. This can come from someone locally in the country. So that is the approach that we took from that standpoint of okay, let's go ahead and have the local group send it out. And then they basically really talked about it from that standpoint via email. It was more of a group that have access to email. All of our employees have access to email, but two thirds of our company, they are production and they are on the floor so we find other ways to get to them. But this is one where we sent an email to the Malaysia group and we thought that that was a great way. So the approach was a little different. We felt like if we hadn't come from shared services, they were like, oh Corpus just sending out another email about some benefit that they wanna provide and they want us to access from that standpoint. So coming kind of full circle to the point that you talked about we do pay for utilization. We are not paying on a P E P M basis. We really look at our benefit utilization a little differently across all of our benefit partners. And with big health we really look at it from a conversion rate. So we know that not everybody needs all of these services that we're providing, but we are trying to meet everybody where they're at. And so from that standpoint, we on the sleepio side, that was something brand new. We had never offered it from our organization standpoint, we had never had anything that could really help people besides just free apps that we were telling people to try. And so that one we took an approach. So we rolled out we started in the US and that's where we've started so far. And we rolled it out at the end of last year from that standpoint. And we did that at a multi-channel communication approach. And so basically from a sleepio standpoint, the thing we were also telling our HR colleagues about was, hey, we have three shifts and a lot of our facilities. So use that as an advantage to say, hey, someone is coming into our organization and we only have second shift available. Remind them that we have this benefit so that they can help themselves when it comes to kind of shifting a shift. Or if we're moving someone from second shift to first shift, make sure they know this resource is available. So when we look at conversion rates, we have a 52% conversion rate for sleepio. So at the time that they sign up and then to the point that they actually have their first visit 52% of people are engaging. And so that's what we're ultimately paying for. On the daylight side, that was one where we were taking the approach of this can really compliment some of our EAP as well to again meet people where they're at, have multiple solutions for a similar component within the benefits offering. And so we are seeing a 38% conversion rate on daylight. So people that are signing up and then ultimately doing that first visit. The one thing I'll also say too is it has really helped on our EAP side as well we continue to promote all these benefits. We do it two times a year together where we basically send a brochure out and we are a little old school, we are mailing to homes a couple times a year as I mentioned, cuz two-thirds of our group is production, they are not in front of a computer, nor do they probably want to get on a computer when they are at home. And so we are doing a couple brochures a year where we talk about our benefits as a whole. So we are a continuously evolving that. But this last year we sent something out in April that said here are your digital benefits, here is benefits to help you save money. Here are benefits that help you from an emotional standpoint. So in a lot of these areas we might have talked about a couple of our benefits more than once because they fit in maybe the digital arena, but they also fit in the save money arena from that standpoint. So again, trying to tie our physical, emotional and financial wellbeing altogether. But from an EAP standpoint, we have seen higher engagement, not necessarily on the counseling side but on the digital URL side where people are looking up more things or they're engaging more on a digital standpoint. So I think that helped too from that standpoint of introducing the sleepio and the daylight and continuing to partner just on that front too, from a communications standpoint, we know that again, everyone is unique and so not only are we bringing all of our benefits together in a couple of those brochures a year, but we are still working with our benefit partners to say, okay, what do you offer as well from a communication standpoint? So we try to engage that. So some of the things we've been doing, one of the things with big health specifically is we worked with them, they sent out a postcard to our employees and if they signed up and engaged they donated money to charity. So we're trying to pull the need a little bit on what kind of gets them interested, whether it's that or with another benefit provider we are leveraging, they throw their name in a hat to get a $25 Visa gift card. So again, trying to kind of say, Hey, let's educate you on the benefits we have, but then hey, here's another extra kind of carrot to get you maybe interested in the benefit. We also try to kind of time things as well so our people don't feel like we're inundating them with benefit information all the time. But again, it's really hard because we're trying to get them at the point that they need it. And that's probably the hardest part of what we're doing day in and day out from that standpoint.

Madleine Makori (24:06):

I love that you brought up a cultural responsiveness with your example in Malaysia with your employees and being very sensitive to their culture their region and what makes sense for them in terms of access to mental healthcare. And I think that's a big piece of digital health, digital medicine cuz it allows you to do a lot of things in privacy. Whereas you may have a background or community or home base where that doesn't allow you to go see a therapist or the belief to see a therapist. And one of the things I didn't bring up it's a little bit in the weeds with clinical, but I think it's important when we talk about that cognitive behavioral therapy techniques that's delivered via therapist for insomnia, for anxiety. We're talking about first line recommendation when we look at clinical guidelines cognitive behavioral therapy is a first line recommendation for insomnia as well as part of the first line recommendation for anxiety. And so being able to be equitable in delivering that with our therapeutics is incredibly important to us because everyone deserves to have first line access. It shouldn't be just straight to medications or you're quiet at home and not being able to support your mental healthcare because of the stigma, whatever other issues may inhibit your access to care. So I definitely appreciate that story. Jen, thank you. I think I will push over to this slide. So just thinking about where digital therapeutics I fit in the mental health care and all of those gaps we talked about wrapping it into a nice box, it's scalable, it's consistent. We want something that we can replicate and get to people quickly and meet them where they're at versus having a delay in access to a therapist or not being able to see a PCP. We want something that's accessible all of the time, 24 7, 365 and that demonstrates that results. I talked about the efficacy of our products. We want to be at with Gold Standard, we want to go out into market and say this is comparable to the gold standard, what you get with a therapist as well as efficacy data that is at par or even better than what you get with medications, but you don't have to move on to the medications or we can support you in your medication journey by getting you that first line recommended treatment of C B T. And so I would love to pause there, Jen, is there anything else you'd like to add before we wrap up from your end?

Jen Paisley (26:25):

No, I mean I just wanna kind of say we are all in this together and it is a journey and it's not a sprint but I mean I think a lot of the data, obviously you have to know your organization. We are a 76 year old organization and I feel like we've kind of had some movement on the executive side. So we have seen a lot of movement and change. But I kind of resonate some of the things that we keep moving the needle on is we always talk about safety as our number one priority from a company because we make big light poles, we make big tell communication poles and those types of things. But tying it to that, so we have partnered a lot with safety on a lot of the things that we do benefits wise. We are on this journey of Belmont Cares and we wanna remind people what we're doing and that we really truly do care about them as an employee and as a family member and as you know, their family grows and those types of things. So we also are trying to remind them we are trying to be with them 24X7. So to that point of accessible, we wanna make sure that they know you have resources available and it's not just during the day, it's at all times knowing that we do have a global organization and even a US organization where we were across the gamut from a time zone standpoint.

Madleine Makori (27:47):

I love that. Thank you. And I'll wrap it up on this slide. So I'm passionate about healthcare outcomes and efficacy, but ROI really matters, especially in this room here. So we do have case studies that support our ROI and this is a specific case study that we did in collaboration with IBM Watson and Dr. Lauren Baker who's out of Stanford University. And we looked at over a thousand employees at a Fortune 500 company and looked at their claims for over 18 months and really looked at the differences in the healthcare utilization and cost. And so to the right, you can see high level data that we were able to pull from this case study. And with that in the SLEEPIO user group. So the individuals that had access to SLEEPIO versus the group in the control group who did not have access to sleepio, we saw a 1600, over $1,600 lower annualized healthcare cost per employee in that sleepio utilizer group as well as lower prescription costs and fewer visits to the emergency department. And so being able to demonstrate that ROI with Sleepio specifically and being able to replicate that is incredibly important. But also demonstrate how important and urgent it is to get that mental health care to individuals instead of delaying care and waiting till it's catastrophic in an emergency. So meeting them where they're at whether they're at the beginning of their journey in the middle or in a place that they really need all types of support we want to be there for them. So with that thank you so much Jen for joining me on stage and thank you all for listening to us. I appreciate your time.